How to Fix Rib Flare: Causes, Symptoms, and Treatment

What is Rib Flare?

Rib flare is a chest abnormality condition where the lower part of the ribcage protrudes out from the rest of the chest. This usually occurs due to the lower ribs and the cartilage connecting these to the breastbone being pulled upward and outward, either due to muscular imbalance or other associated conditions. Flared ribs will usually become more obvious when you raise your arms over your head. This condition is surprisingly common and can be congenital (present from birth) or caused by other factors such as injuries or muscular problems. 

Some people with a flared rib cage will have an equal amount of flaring on both sides; however, it is more common for sufferers to have an uneven rib cage with more flare on the left side of the chest, where most of the internal organs are located (heart, stomach, pancreas, etc.). Some people may also show rib flattening or even a slight depression in the upper portion of their chest where the ribs are not flared. Again, this most commonly affects only one side of the body. 

Rib flare is often seen as primarily an aesthetic consideration. From this perspective, remedial treatment will help improve a person’s self-image of their body and their quality of life. However, there are also some subtle health problems that a flared rib cage can cause. Continually having the ribs in this position means that the diaphragm and other abdominal muscles must work harder to breathe. Furthermore, flared ribs pull the spine forward and tilt the pelvis backward, which can increase the risk of back and shoulder injury. Consequently, it is important to understand the cause of your rib flare and how to treat it effectively.

What Causes Rib Flare?

There are many possible causes of rib flare. In some people, this condition is present from birth (congenital) and is often associated with other chest conditions, specifically pectus excavatum or pectus carinatum. These conditions have a genetic link and result from improper cartilage growth in the breastbone. Congenital cases of rib flare may also rarely occur in isolation.[1] In congenital cases, rib flare will often become more noticeable during puberty. 

Another common cause of flared out ribs is muscle-related. In contrast to rib flaring associated with pectus carinatum or excavatum, these cases of rib flare occur due to problems with the chest/abdominal muscles rather than a physical abnormality of the costal cartilage. This may be a result of muscular imbalance or from muscular weakness, or injury. A muscular imbalance may develop from poor breathing habits, where a person uses their lower chest muscles for breathing rather than their diaphragm. Over-activity in these chest muscles can then pull the ribs upward and outward, causing them to protrude. Muscular weakness/injury is usually linked to other primary causes. For example, postpartum damage to the abdominal muscles may result in flared ribs. 

Finally, postural issues can also cause rib flaring. These include scoliosis (where the spine is curved sideways) and hyperlordosis (where the lower part of the spine is excessively curved from front to back).

How to Correct Rib Flare

The first step in correcting rib flare is to correct your posture. It is important to avoid excessive arching of the lower back (hyperlordosis) and to maintain the ribs in a neutral position. 

Physiotherapy exercises may be useful for treating the appearance of flared ribs, particularly in mild cases. Most often, this will take the form of abdominal exercises to strengthen the core muscles, and breathing exercises to realign the ribs. Other exercises may help loosen muscles in the lower back to reduce hyperlordosis, or to consciously focus on breathing with the diaphragm. To be effective, these exercises require a significant investment of time and effort by the patient. 

In addition, it is important to note that exercises will not treat underlying chest abnormality conditions, such as pectus carinatum or pectus excavatum. An orthotic rib brace is generally recommended as the first line of action for these patients. It is important to note that orthotic braces for rib flare are extremely different to rib binders or belts, which are intended to reduce chest pain from fractured ribs or other injuries. Rib binders apply pressure from all sides of the chest, which can actually push the flared ribs further forward. Similarly, chest braces intended for treating pectus carinatum can also worsen rib flare.[2] In contrast, a well-designed orthotic brace specifically for correcting rib flare provides only front-to-back pressure, pushing the flared ribs back to their proper location. Over time, this helps remodel the breastbone cartilage into its proper shape, further into the chest. Bracing is most effective when used early in the commencement of puberty (ages 12-16); however, adults may also see some benefit from its use. 

The brace must be regularly worn to be effective; hence it should be well-suited to your body shape. That is where custom-made rib flare braces from Dakota Brace can help, like our Rider Brace or Bison Brace. Combination braces are also available to treat people who suffer from both rib flare and pectus carinatum. 

Finally, surgery should be the last line of resort for treating rib flare. Surgical procedures are usually very invasive and often necessitate breaking and repositioning the ribs. Some less-invasive procedures are available [3]; however, treatment of rib flare through surgery remains a challenge for surgeons. Surgical treatment for other associated conditions — specifically pectus carinatum or pectus excavatum — generally do not improve rib flare and may actually worsen it. However, as the pectus condition is corrected over time following surgery, the rib flare may gradually become less prominent.

Conclusion

Rib flare can be a significant condition — not only for its aesthetic appearance, but also for the potential to induce further complications, such as back and shoulder injury. 

Are you ready to take charge of your health? Would you like to speak with our certified health professionals about how to treat rib flare with a high-quality, custom-made rib flare brace? Get to get a free consultation and $75 off your first order, and get evaluated for either our Custom Rib Flare Brace (The Rider Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace).

References

1. Haleem, A., Hanif, M. S., Majeed, F. A., Wyne, A., & Rahim, K. (2015). Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment. PAFMJ, 65(2), 170-174.
2. Hunt, I., & Patel, A. J. (2020). Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review. The Thoracic and Cardiovascular Surgeon, 68(01), 072-079.
3. Bosgraaf, R. P., & Aronson, D. C. (2010). Treatment of flaring of the costal arch after the minimally invasive pectus excavatum repair (Nuss procedure) in children. Journal of Pediatric Surgery, 45(9), 1904-1906.